Anxiety Disorders Underdiagnosed
Finn, Robert, Clinical Psychiatry News
PHOENIX, ARIZ. -- Psychiatrists may be dramatically underdiagnosing anxiety disorders, Joshua E. Wilk, Ph.D., reported at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.
Undertreatment appears to be a problem as well, he said.
Overall, 23.8% of psychiatric patients received an anxiety disorder diagnosis from psychiatrists. In contrast, the National Comorbidity Survey (NCS), which used structured diagnostic interviews, calculated an anxiety disorder prevalence of 68.1% among 154 psychiatric patients.
Psychiatrists were surveyed during the Study of Psychiatric Patients and Treatments (SPPT), sponsored by the American Psychiatric Institute for Research and Education, where Dr. Wilk is a research scientist. In this survey, conducted in 1997 and 1999, a representative sample of 754 psychiatrists completed patient logs on the next 12 patients they saw after a randomly assigned start time. Dr. Wilk's study included data from 2,117 patients aged 15-54 years with at least one psychiatric diagnosis. For some analyses, he included data from 1,843 patients seen during the 1999 survey.
The apparent underdiagnosis was especially noticeable with phobias, which were 22 times more likely to be diagnosed in the NCS sample than in the SPPT sample. Generalized anxiety disorder was diagnosed three times as often; posttraumatic stress disorder, five times as often; and panic disorder, more than twice as often in the NCS sample, compared with the SPPT sample.
"Psychiatrists seem to be detecting the anxiety symptoms, but they're not making a diagnosis for whatever reason," Dr. Wilk said in an interview with this newspaper. When patients from the SPPT with a DSM-IV diagnosis of an anxiety disorder were combined with those whose psychiatrists noted moderate to severe anxiety symptoms without making a formal diagnosis, the percentage of patients with reported anxiety symptoms increased to 54.7%. While that is higher than the 23.8% of patients with a formal diagnosis, it is still lower than the 68.1% prevalence found by the NCS.
A substantial proportion of patients in the SPPT with a formal diagnosis seem to be receiving substandard treatment, Dr. …